• Chronic pain appears to play a meaningful role in raising the risk of developing high blood pressure.
• How long the pain lasts and where it occurs both influence that risk, and part of the connection is explained by depression and inflammation.
• Researchers say the results underscore how important effective pain management can be for preventing and controlling high blood pressure, a major driver of cardiovascular disease and death.

Chronic Pain Linked to Rising Blood Pressure Risk

Chronic pain in adults may raise the likelihood of developing high blood pressure, and factors such as where the pain is located, how widespread it is, and whether a person also has depression appear to play important roles. These findings come from new research published today (November 17) in Hypertension, an American Heart Association journal.

An evaluation of health information from more than 200,000 adults in the U.S. showed that individuals who experienced chronic pain throughout their bodies had a higher chance of developing high blood pressure compared to those reporting no pain, short-term discomfort, or pain limited to one region.

"The more widespread their pain, the higher their risk of developing high blood pressure," said lead study author Jill Pell, M.D., C.B.E., the Henry Mechan Professor of Public Health at the University of Glasgow in the United Kingdom. "Part of the explanation for this finding was that having chronic pain made people more likely to have depression, and then having depression made people more likely to develop high blood pressure. This suggests that early detection and treatment of depression, among people with pain, may help to reduce their risk of developing high blood pressure."

Understanding High Blood Pressure and Its Dangers

High blood pressure and hypertension occur when blood presses too strongly against vessel walls, increasing the chance of heart attack or stroke. High blood pressure, including stage one or stage two hypertension (blood pressure readings from 130/80 mm Hg to 140/90 mm Hg or higher), affects nearly half of adults in the U.S. It is also the leading cause of death nationally and worldwide, according to the 2025 joint American Heart Association/American College of Cardiology guideline endorsed by 11 other organizations.

Earlier studies show that chronic musculoskeletal pain -- pain in the hip, knee, back or neck/shoulder that lasts for at least three months -- is the most common form of long-term pain in the general population. The new study examined how the presence, type, and distribution of pain across the body relate to later high blood pressure.

Inflammation and depression are already recognized as contributing factors for high blood pressure; however, Pell noted that no previous research had evaluated how much these elements might explain the connection between long-lasting pain and future hypertension.

How Researchers Collected and Measured Pain Data

Participants completed a baseline questionnaire describing whether they had experienced pain in the previous month that interfered with daily activities. They identified whether the pain occurred in the head, face, neck/shoulder, back, stomach/abdomen, hip, knee or across the entire body. Those reporting pain also indicated whether symptoms had persisted for more than three months.

Depression was assessed through a questionnaire asking about depressed mood, disinterest, restlessness or lethargy during the previous two weeks. Inflammation was measured using blood tests for C-reactive protein (CRP).

Key Findings After Long-Term Follow-Up

After an average follow-up period of 13.5 years, the results showed:

• Nearly 10% of all participants developed high blood pressure.
• Compared to people without pain, those with chronic widespread pain faced the greatest increase in risk (75% higher), while short-term pain was associated with a 10% higher risk and chronic pain in a single location was tied to a 20% higher risk.
• When looking at pain locations, chronic widespread pain was linked to a 74% higher risk of high blood pressure; chronic abdominal pain to a 43% higher risk; chronic headaches to a 22% higher risk; chronic neck/shoulder pain to a 19% higher risk; chronic hip pain to a 17% higher risk; and chronic back pain to a 16% higher risk.
• Depression (11.3% of participants) and inflammation (0.4% of participants) explained 11.7% of the connection between chronic pain and high blood pressure.

"When providing care for people with pain, health care workers need to be aware that they are at higher risk of developing high blood pressure, either directly or via depression. Recognizing pain could help detect and treat these additional conditions early," Pell said.

Expert Perspective on Pain, Inflammation and Hypertension

Daniel W. Jones, M.D., FAHA, chair of the 2025 American Heart Association/American College of Cardiology High Blood Pressure Guideline and dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi, said, "It is well known that experiencing pain can raise blood pressure in the short term, however, we have known less about how chronic pain affects blood pressure. This study adds to that understanding, finding a correlation between the number of chronic pain sites and that the association may be mediated by inflammation and depression."

Jones, who was not involved in the study, recommended further research using randomized controlled trials to explore how different pain management strategies influence blood pressure. He highlighted the importance of understanding how Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen may raise blood pressure.

"Chronic pain needs to be managed within the context of the patients' blood pressure, especially in consideration of the use of pain medication that may adversely affect blood pressure," said Jones.

Study Limitations and Participant Characteristics

The researchers noted that the study population mainly consisted of middle-aged or older white adults of British origin, which means the findings may not apply to people of other racial or ethnic backgrounds or younger age groups. Pain levels were self-reported, and the study relied on clinical diagnostic coding, a single pain assessment, and two blood pressure measurements.

How the Study Was Designed

Study details, background and design:

• The analysis used data from the UK Biobank, a large population-based project that recruited more than 500,000 adults ages 40-69 between 2006 and 2010. Participants lived in England, Scotland and Wales.
• This study focused on 206,963 adults. The average age was 54 years; 61.7% were women, and 96.7% were white adults.
• Overall, 35.2% of participants reported chronic musculoskeletal pain; 62.2% reported chronic pain at one body site; 34.9% had chronic pain at two to three musculoskeletal sites; and 3.2% reported pain at four sites.
• Compared with participants without pain, those reporting pain were more often women, had less healthy lifestyle patterns, larger waist circumference, higher body mass index (BMI), more long-term health issues, and were more likely to live in areas with higher unemployment, lower home and car ownership, and more overcrowding.
• Researchers adjusted for factors associated with both pain and high blood pressure, including self-reported smoking status, alcohol intake, physical activity, sedentary time, sleep duration, and fruit and vegetable consumption.
• Data from the UK Biobank was gathered through a touch-screen questionnaire, interview, physical measurements (height, weight, BMI, waist circumference, blood pressure), and blood samples for cholesterol and blood sugar (hemoglobin A1c).
• Hospital records were used to identify high blood pressure using standard International Statistical Classification of Diseases and Related Problems and diagnostic codes (ICD-10 codes).
• The follow-up period was measured from baseline until one of these events occurred: a diagnosis of high blood pressure, the participant's death, or the end of available follow-up records. The first of these events marked the end of follow-up for each participant.

• Researchers used whole genome sequencing to bring together monogenic and polygenic testing, two methods that are usually separated in both research and clinical practice.
• Experts say many more physicians should be using genetic testing, although a large portion of the medical workforce is not yet trained to interpret it.
• The results provide an early foundation for creating targeted treatments tailored to each person's unique genetic profile.

New Genetic Approach to Predicting Dangerous Heart Rhythms

In a new study from Northwestern Medicine, researchers have created a more refined genetic risk score that helps determine whether a person is likely to develop arrhythmia, a condition in which the heart beats irregularly. Arrhythmias can lead to serious medical problems, including atrial fibrillation (AFib) and sudden cardiac death.

The team reports that this improved method strengthens the accuracy of heart disease risk prediction while also offering a broad framework for genetic testing. According to the scientists, the same strategy could be adapted to assess other complex, genetically influenced conditions such as cancer, Parkinson's Disease and autism.

Building a More Complete Genetic Picture

"It's a very cool approach in which we are combining rare gene variants with common gene variants and then adding in non-coding genome information. To our knowledge, no one has used this comprehensive approach before, so it's really a roadmap of how to do that," said co-corresponding author Dr. Elizabeth McNally, director of the Center for Genetic Testing and a professor of medicine in the division of cardiology and of biochemistry and molecular genetics at Northwestern University Feinberg School of Medicine.

The researchers say their findings could support the development of targeted treatments shaped around an individual's full genetic profile. They also note that this type of analysis may allow clinicians to identify people at risk long before any symptoms arise.

The study, which analyzed data from 1,119 participants, was published on November 11 in Cell Reports Medicine.

Integrating Three Major Genetic Testing Methods

Current genetic testing typically falls into one of three separate categories:

• Monogenic testing: Identifies rare mutations in a single gene, similar to spotting a typo in a single word.
• Polygenic testing: Looks at many common gene variants to estimate overall risk, similar to examining the tone of a chapter.
• Genome sequencing: Reads the complete genetic code, much like reviewing an entire book.

"Genetic researchers, companies and geneticists often operate in silos," McNally said. "The companies that offer gene panel testing are not the same ones that provide polygenic risk scores."

In this study, the team combined information from all three genetic sources to produce a fuller view of disease risk. This integrated method uncovers rare mutations, evaluates cumulative genetic effects and reveals subtle patterns across the entire genome.

"When you sequence the whole genome, you can say, 'Let me look at this cardiomyopathy gene component, the gene panel and the polygenic component.' By combining the data together, you get a very high odds ratio of identifying who is at highest risk, and that's where we think this approach can really improve upon what is currently used," McNally said.

Why Physicians Need Greater Access to Genetic Testing

Cardiologists usually assess heart risk based on symptoms, family history and diagnostic tools such as EKGs, echocardiograms and MRIs. McNally said she also incorporates genetic testing into her patient evaluations.

"It helps me manage that patient better, know who's at greatest risk, and if we think the risk is really high, we'll recommend defibrillators for patients like that," McNally said. "Knowledge is power."

Despite the benefits, genetic testing remains underused. McNally said that only an estimated 1 to 5% of people who would benefit from genetic testing actually receive it. Even within cancer care, where genetic links are widely recognized, only 10 to 20% of eligible patients undergo testing.

"We need to improve uptake," McNally said. "The biggest challenge is a workforce that isn't trained in how to use genetic testing. As polygenic risk scores become more common, our approach will become even more valuable."

How Researchers Carried Out the Study

The research team enrolled 523 people diagnosed with arrhythmias, some of whom also had heart failure. They thoroughly reviewed each participant's records, including data directly from implanted devices, to confirm the diagnoses. Afterward, the scientists sequenced each person's genome and used both monogenic and polygenic testing to calculate a risk score.

They then compared these results to the genomes of 596 control participants drawn from the NUgene biobank. These control individuals were age 40 or older and had no known history of cardiac disease.

"It was painstaking going through 500-plus records and making sure that the people in the study really belonged in the study," McNally said.

The paper is titled "A combined genomic arrhythmia propensity score delineates cumulative risk." Additional Northwestern contributors include Tanner Monroe, Megan Puckelwartz, Lorenzo Pesce, Dr. Alfred George and Dr. Gregory Webster.